Effect of a Family Planning Program on Long-Acting Reversible Contraceptive Use in HIV-Negative Single Mothers: Results From a Prospective Cohort Study in Zambia Open Access

Li, Jessica (Spring 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/w6634459j?locale=en


Introduction: Long-acting reversible contraception (LARC) use in developing countries remains remarkably low. We implemented a family planning (FP) program which integrates counseling and education with access to LARC methods among HIV-negative Zambian single mothers (SM). This study evaluates how fertility intentions affect LARC utilization in this population. Our primary outcome was LARC use throughout study participation. We also estimated rates of LARC uptake, LARC discontinuation and incident pregnancy within this cohort.

Methodology: As part of a prospective cohort study on HIV incidence in high-risk women, we recruited 521 HIV-negative SM between the ages of 18-45 years (median age 22, IQR 20-25 years) in Lusaka and Ndola, Zambia. Participants were followed every three months for up to five years. At each visit, participants who were not pregnant and who were not already using a LARC or permanent contraceptive method were offered a LARC method. Data was collected on demographic factors, sexual behavior and sexual and reproductive history. Multivariable logistic regression was used to model baseline fertility intentions with LARC use.

Results: 518 Zambian SM were enrolled, and 57 women did not return for any follow-up visits. There was a significant increase in LARC use during the study. At baseline, 93/518 (18%) of participants were using a LARC method, and 99 women initiated LARC during the study, leading to 151/461 (33%) total LARC users at the end of follow-up (p-value < 0.0001). Women who did not desire any more children in Ndola were more likely to use a LARC method after adjusting for other confounders (aPOR = 2.02, p-value = 0.0094). During follow-up, 37/183 (20%) of LARC users discontinued their method, and women who desired future children at baseline were more likely to discontinue (p-value = 0.0071). There were 59 incident pregnancies in 461 women (8.98 per 100-women years).

Discussion: This study demonstrates that an integrated FP program can successfully increase LARC use among SM, who are disproportionately affected by high rates of unintended pregnancy. It is imperative that FP interventions target SM in developing countries to overcome obstacles in reproductive health.

Table of Contents

1.    INTRODUCTION                                                                                          1

2.    BACKGROUND                                                                                              3

2.1. Unintended Pregnancy                                                                               3         

2.2. LARC Use                                                                                                     3

2.3. Vulnerable Populations                                                                              4

2.4. Fertility Intentions                                                                                      5

2.5. Contraceptive Method Discontinuation                                                 6

3.    METHODS                                                                                                     8

3.1. Study Participants                                                                                       8

3.2. Study Design                                                                                                 9

3.3. Outcome Measures                                                                                      9

3.4. Statistical Analysis                                                                                     10

3.5. Individual Interviews                                                                                 12

3.6. Ethics                                                                                                             13

4.    RESULTS                                                                                                        14

4.1. Baseline Characteristics                                                                            14

4.2. Fertility Goals and LARC Use                                                                  14

4.3. LARC Uptake                                                                                              15

4.4. LARC Discontinuation and Method Switching                                     16

4.5. Individual Interviews                                                                                 17

4.6. Incident Pregnancy                                                                                    17

5.    DISCUSSION                                                                                                 19

5.1. Fertility Intentions and LARC Use                                                           19

5.2. IUD vs. Implant Use                                                                                    21

5.3. LARC Method Discontinuation                                                                21

5.4. Incident Pregnancy                                                                                     22

6.    REFERENCES                                                                                                26

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